Northfield Lodge Care Home Service

Northfield Lodge Care Home Service Provost Fraser Drive Northfield Aberdeen AB16 7JY Telephone: 01224 680606 Type of inspection: Unannounced Inspection completed on: 10 August 2016 Service provided by: Aberdeen Association of Social Service, a company limited by guarantee, trading as VSA Service provider number: SP2003000011 Care service number: CS2003000170

About the service Northfield Lodge is situated in a large building set in a residential area of Aberdeen. The unit aims to provide flexible levels of support, to enable service users to live in the community as safely and independently as possible. The service provider is VSA (Aberdeen Association of Social Services). VSA provides care and support for adults and children in the North East of Scotland. The care provider's head office is based in Aberdeen. The VSA vision is to build a strong and caring community and to provide the best care and support to enable local communities to fulfil potential. The vision and mission are based on shared values as an organisation, such as: - Our service users' needs will be at the heart of our policies, planning and work. - We will work to provide the best care to meet our service users' needs. - We will embrace, promote and foster partnerships to deliver our services in the most appropriate way for our service users. - We will respect and value our service users, partners, volunteers and staff. The philosophy for service provision is a reflection of the above agency vision, mission and values. What people told us Conversations had taken place with service users over the two days of inspection. We spent time in the company of service users throughout the inspection. We spoke informally with service users during this time. Some comments made by supported people, both in person and on questionnaires returned to us included: "They help me with my care plan." "I feel they support me very well." "Most of the time I feel they help me be independent." "They treat me very well and as an individual." "I feel that you can't get to know them properly because some staff don't stay long." "Staff give a good service." "Staff treat me with respect and dignity." "We have service user meetings to air our opinions and staff listen to the service users thoughts." "I am very pleased with the service." "I am very content." page 2 of 13

"If there is anything worrying or upsetting, staff have time to listen and I have my input at reviews." "I am really happy here and staff are always helpful." "I know I can approach staff to talk about anything." "The service takes into consideration my needs and wants." "I know I can approach staff. My monthly summary also gives me a chance to express my views." "I haven't made a complaint yet but I know I can go to my co-keyworker or keyworker if I do." "The staff are very nice and treat me well." "There has been a lot of new staff over a long time." "I know I can approach staff and that they will listen." "I think the lodge could look a bit more modern." Carers include guardians, relatives, friends and advocates. They do not include care staff. We did not speak to any carers at this inspection. Self assessment The Care Inspectorate received a fully completed self-assessment document from the provider. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We were satisfied with the way the provider completed this and with the relevant information included for each heading that we grade services under. We also reviewed information we had received from the provider since our previous inspection. From this inspection we graded this service as: Quality of care and support Quality of environment Quality of staffing Quality of management and leadership 5 - Very Good 5 - Very Good 5 - Very Good 5 - Very Good Quality of care and support page 3 of 13

Findings from the inspection At this inspection, we found the services quality of care and support to be very good. We thought this after we observed interactions between staff and people using the service and looked at records. We also spoke with people who used the service and viewed feedback from recent questionnaires. We spoke with service users, staff and managers, looked at feedback from questionnaires and written records, which confirmed the management team was seeking the views of others in order to improve the service. Staff were genuine, caring and welcoming and we observed interactions, which were warm and sensitive to people's needs. People seemed to be relaxed and comfortable in their surroundings, which were pleasantly decorated and homely. There was a garden area, which was easily accessible for people using the service and was used throughout our inspection. We observed people having choice, spending time in communal areas, and enjoying space in their own rooms when they wanted. There were opportunities to take part in social activities, which reflected people's individual likes and dislikes. People we spoke to using the service said they enjoyed the activities on offer. Medications were being managed in line with good practice guidance. During this inspection, we were told that a new medication policy was now in use and the procedure would be approved by the executive team soon. People were being supported to maintain their health and wellbeing. A risk-based approach was taken to manage people's varied needs in order to be person centred and allow supported people to take risks while not being over protected. Various risk assessments were in place and were reviewed regularly. We thought support plans were informative about the care and support required. We saw they were reviewed on a regular basis and supported people were included in this process. The service was in the process of implementing recovery focussed support plans. These plans were being developed to provide support that would help people lessen the impact of mental health problems by setting realistic, achievable goals set out by the supported person (www.scottishrecovery.net). Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 5 - very good Quality of environment page 4 of 13

Findings from the inspection The management team were able to provide very good evidence that the environment was safe and service users were protected. Cleaners were employed by the service in order to do daily cleaning tasks in the communal areas and kitchen staff were responsible to upkeep of the kitchen area. The kitchen was currently being painted and cleaned and new shelving being situated in pantry areas. Service users had rooms that were very individual to them. They had their own pictures, soft furnishings and chosen décor for bedrooms. Service users were responsible for upkeep of their rooms with staff assistance when required. A tour of the premises showed the service was clean and homely. The service was found to be safe and secure with staff being aware of where all supported people were at any given time. We thought this because: - There was a secure entry system to the service and a checking in/out board. - Service users discussed the environment during their meetings. - Safety checks were carried out within the service. - The provider had policies and procedures around safety and risk assessment for the staff to follow. There were very detailed risk assessments to ensure service users safety both within the home, outside and when on activities or outings. These were completed in a way which allowed people to take risks and be safe without being over-protected. These were regularly reviewed and updated as needed. There was an infection control policy in place. The service demonstrated that there were very good systems in place to ensure the safety of service users, staff and visitors. These included: - maintenance contracts for equipment - refrigerator and freezer temperature checks - food temperature recordings - testing of electrical appliances (PAT) - faults log - visits from the Fire Service - lift maintenance. Secure storage was in place for medication, cleaning products and money. The staff had undertaken a variety of training opportunities in relation to safety which is discussed further under quality of staffing. There is a contingency plan in place for the home, to protect people in emergencies and maintaining the service. Service users had emergency plans in place which they were aware of and to account of any impairment. Requirements Number of requirements: 0 page 5 of 13

Recommendations Number of recommendations: 0 Grade: 5 - very good Quality of staffing Findings from the inspection The management team was able to provide very good evidence for the quality of staffing at service. The provider ensured this by operating to a range of policies and procedures that supported staff practice and development including safe recruitment, learning and development, supervision and appraisal, health and safety and fire safety to name a few. We saw that these policies and procedures were regularly reviewed and updated. To make sure staff maintained good practice there was a programme of team meetings, supervision and appraisal. We saw staff discussed a range of practice and service issues at these meetings. Staff also did reflective practice exercises at team meetings as a way of studying their own experiences to improve work practices. We looked at staff support records and noted staff support and appraisal was done on a regular basis. We also looked at staff training records and staff training was up to date, particularly training for adult protection, medication administration, continence care and report writing. Staff were PVG (Protection of Vulnerable Groups) scheme members which means they were police checked and suitable to work with vulnerable adults. Staff were registered with the Scottish Social Services Council (SSSC) as required. Staff had or were working on Scottish Vocational qualifications (SVQ) in line with their job role. During recent recruitment none of the service users wished to participate in the actual interviews but did participate in the service visits where they met with prospective staff and then let the management team know what they thought. Staff we spoke with enjoyed working at Northfield lodge and morale was seen to be a very good due to being fully staffed and the service having more stability now that secondments had ended. We discussed various best practice initiatives, including accessing websites such as the Care Inspectorate's 'The Hub', the Social Services Knowledge Scotland (SSKS) and SSSC step into leadership pathway and continuous learning frameworks for staff to further develop their reflective practice sessions. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 5 - very good page 6 of 13

Quality of management and leadership Findings from the inspection At this inspection, we found the performance of the service for this quality theme to be very good. We reached this conclusion after we spoke with staff and people who used the service and looking at quality assurance records made available to us. People's wellbeing and quality of life were priorities of the management and staff. This approach was reflected in what people told us. There is a service users' forum which a representative from Northfield Lodge attends. Minutes from this group are circulated to service users. The open door policy was applicable not only to staff but to service users and relatives and they all felt confident to speak to the management team if they felt they had any concerns or problems. The staff were encouraged through keyworking and co-keyworking roles to exercise autonomy and take the lead in supporting service users. Satisfaction surveys were issued to service users, carers and external professionals to give them a way to express their views about the service. There was a suggestion box in place for service users to comment on the service. The service acted on any suggestions or concerns raised. The service had a complaints procedure in place. This meant that if people had any issues, they would be addressed. We noted when we looked at accidents and incidents these were managed well. Management would identify what went wrong, what needed to be changed or put in place and what actions needed to be taken along with support for service users or staff who were involved. The service was good at letting us know about things happening in the service they are required to report. We discussed with the management team the document 'Records that all registered care services (except childminding) must keep and guidance on notification reporting' in order to ensure this good practice continues. An organisation wide quality assurance framework was seen to be in place. This included a range of processes and procedures that were used to measure the quality of service provided including audits of care plans, staff records and health and safety. Requirements Number of requirements: 0 Recommendations Number of recommendations: 0 Grade: 5 - very good page 7 of 13

What the service has done to meet any requirements we made at or since the last inspection Previous requirements Requirement 1 The home must complete a staffing needs analysis in order to ensure that at all times suitably qualified and competent persons are working in the care service in such numbers as are appropriate for the health, welfare and safety of service users. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011, No210: Regulation 15 (a) - Timescale for implementation: within 28 days of receipt of this report. When we made this requirement we also took into consideration the following: National Care Standards Care Homes for People with Mental Health Problems - Standard 5: Management and Arrangements. This requirement was made on 11 January 2016. Action taken on previous requirement A staffing needs analysis was completed by the management team. The management team discussed the existing staffing structure and levels with the team at a team meeting dated 25-1-16. Subsequently vacancies were posted and applicants were interviewed. New members of staff have started and inductions have been completed. Secondments have finished and staff have resumed their posts at the service. The manager and team leaders had ensured shifts were covered in accordance with the staffing schedule, adjustments had been made to staff rota meantime until vacant posts were filled using peripatetic/relief staff to cover shifts where required. The service is now fully staffed. Met - within timescales page 8 of 13

What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The provider should review their current medication policy and procedure and update it to current best practice and legislation. This should also include care home services where staff administer the medication to see the NHS prescription forms for all medicines before they are sent to the pharmacy for dispensing. This is to ensure that all medicines administered are still currently prescribed for the service user to keep them healthy and safe, and that all records have been checked against the original prescription before they are put into use. When we made this recommendation, we also took account of: National Care Standards care homes for people with learning disabilities. Standard 15: keeping well - medication. Care Inspectorate guidance about medication personal plans, review, monitoring and record keeping in residential care services 2012. Health Guidance: Maintenance of Medication Records and Authorisation to administer medications The Royal Pharmaceutical Societies best practice guidance: The handling of medicines in social care. This recommendation was made on 11 January 2016. Action taken on previous recommendation The director of adult services had revised the medication policy which had been approved by the board and is had now been fed down through managers to staff teams. The medication policy had been added to the policy folder and induction handbooks. New training had been developed for staff along with a competency based assessment in relation to administration of medication. Staff have completed assessments for supported people to determine how much assistance is required for medication. Copies of prescriptions were now on file for supported people who required full support. Recommendation 2 We recommend the service assess the risks to residents having fire doors propped open and takes the necessary actions to minimise those risks to ensure that the environment is designed to protect residents. National Care Standards Care Homes for People with Mental Health Problems - Standards: 4.2/4.9 - Your Health and safety in care homes (2014) from the Health and Safety Executive This recommendation was made on 11 January 2016. Action taken on previous recommendation All doors in the service have now been fitted with automatic door closures, this was completed in February 2016. page 9 of 13

Recommendation 3 We recommend on weekends staff maintain safe food hygiene practices by ensuring the temperature of any cooked or reheated foods and refrigerator and freezer temperatures are recorded appropriately and take action as necessary if these are not within safe parameters. National Care Standards Care Homes for People with Mental Health Problems - Standards: 4.2/4.3 - Your. When we made this recommendation, we also took account of: CookSafe Food Safety Assurance System - Issue 1.1, May 2012 This recommendation was made on 11 January 2016. Action taken on previous recommendation The manager discussed food hygiene with the staff team at a team meeting on 25.01.16. The team leaders now check to ensure fridge/freezer and food temps are recorded at weekends. The cook also audits temperature records every Monday and informs the senior staff on duty of any non compliance so it can be addressed quickly. When we looked at records we noted recordings had been completed as required. The service had also had an external audit completed for kitchen hygiene and safety and actions from this had been addressed in a timely fashion by the service. Recommendation 4 We recommend that the service access the training required in order to maintain skills and refresh best practice in order to better understand the needs of the people being supported. National Care Standards Care Homes for People with Mental Health Problems - Standard 5: Management and Arrangements. This recommendation was made on 11 January 2016. Action taken on previous recommendation There is a new training bulletin published by learning and development department and we looked at the most recent bulletin from June 2016. Training bulletins are now discussed at staff team meetings. Continence advisory service has been out to complete training for staff on 17th February 2016. The provider has now added a continence e-learning course for staff to access. Learning and development team also developed a new record keeping course which will be supplemented by an e-learning record keeping course. Complaints There have been no complaints upheld since the last inspection. Details of any older upheld complaints are published at www.careinspectorate.com. page 10 of 13

Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 11 Jan 2016 Unannounced Care and support Management and leadership 17 Jun 2014 Unannounced Care and support Management and leadership 15 Aug 2013 Unannounced Care and support Management and leadership 27 Jul 2012 Unannounced Care and support Management and leadership 5 Aug 2011 Unannounced Care and support Management and leadership 8 Nov 2010 Unannounced Care and support Management and leadership 17 Jun 2010 Announced Care and support page 11 of 13

Date Type Gradings Management and leadership 26 Jan 2010 Unannounced Care and support Management and leadership 13 Aug 2009 Announced Care and support Management and leadership 3 - Adequate 27 Jan 2009 Unannounced Care and support Management and leadership 17 Sep 2008 Announced Care and support Management and leadership page 12 of 13

To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and help services to improve. We also investigate complaints about care services and can take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. You can also read more about our work online at www.careinspectorate.com Contact us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 Find us on Facebook Twitter: @careinspect Other languages and formats This report is available in other languages and formats on request. Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas. page 13 of 13